With Pfizer’s Xeljanz snapping up new indications and AbbVie’s upadacitinib on the way, makers of anti-inflammatory drugs will soon feel the heat from JAK inhibitors if they haven't already. But some will feel it more than others, Bernstein analysts say.

Makers of drugs for rheumatoid arthritis are the ones who really need to watch out, Bernstein’s Ronny Gal wrote to clients on Tuesday. JAK inhibitors have posted “strong” efficacy data in the disease versus other drug classes, and JAKs’ side effects—which can include infections and elevated cholesterol—are “more acceptable” in that setting.

Overall, he sees JAKs going on to snatch a 24% chunk of the market, which is bad news for products such as Amgen’s Enbrel. That drug’s decline “will accelerate as physicians increasingly use JAKi as the second drug after (AbbVie’s) Humira, instead of trying a second aTNF (Enbrel).”

3-Day Conference

The leading U.S. event devoted to building the skills, speed and teamwork of your promotional review committee members will take place May 15–17, 2019 in Chicago. The conference is set to bring together more than 75 professionals to ensure your PRC is prepared to generate, collect and constructively act on expert comments for your entire drug and device portfolio.

In inflammatory bowel disease, though, they’ll make less of a mark; Gal predicts they’ll wind up with a 12% market share. The reason? So far, efficacy data has only been “decent” in ulcerative colitis and “moderate” in Crohn’s, he wrote. And on top of that, multiple other classes will hit the market at the same time JAKs do.

That doesn’t mean JAKs won’t cause problems for Celgene, which is developing candidate ozanimod in both ulcerative colitis and Crohn’s. By the time ozanimod could potentially reach the market, Xeljanz should have an 18-month lead in ulcerative colitis, as well as leverage with payers, Gal figured.

The way he saw it, though, Celgene can relax when it comes to JAK competition for its psoriasis drug, Otezla. “JAKs will likely not be used in Otezla's core market of psoriasis and do not look particularly promising” in psoriatic arthritis, he wrote. Regeneron and Sanofi, which market atopic dermatitis treatment Dupixent, face “limited risk,” too.

In addition to out-of-class rivals, makers of JAK drugs have one another to worry about. Most payers will have at most one member of the class co-preferred, according to Gal, and doctors will switch to other classes after trying a single JAK in patients.

“Prices will likely be flat and competition for preferred will likely pit Xeljanz (PFE's incumbent) and upadacitinib (ABBV) against each other,” he wrote, noting that AbbVie’s stellar formulary positioning with Humira could help it gain an edge.